The impact of preoperative chlorhexidine baths on outcomes in pediatric patients undergoing adnexal surgery

Author(s):
Javier Valdes; Monique Motta; Azalia Avila; Shenae Samuels; Tamar Levene

Background:

Surgical site infections (SSIs) increase the risk of mortality, length of hospital stay and health care costs.  Pre-operative bathing protocols with antiseptic agents such as chlorhexidine 4% (CHG) have been implemented in many institutions. Although there is data supporting this practice for select cases, its efficacy in adnexal surgery among pediatric patients is unknown.

Hypothesis:

Pre-operative bathing with CHG does not lead to improved outcomes for pediatric patients undergoing adnexal surgery.

Methods:

We conducted a retrospective chart review of 115 non-neonatal, pediatric patients who underwent adnexal surgery from November 2017 to November 2022. Rates of SSIs, returns to emergency room (ER) and readmissions were compared for patients who did or did not receive a pre-operative antiseptic bath using CHG.  Statistical analysis was conducted using Pearson’s chi-square test or Fisher’s exact test for categorical variables and independent t-tests for continuous variables with statistical significance at p<0.05.

Results:

The mean age at time of surgery was 13.3 years (range 0.75-20 years) with most patients identified as white (67.8%) followed by black (25.2%) and nearly half being Hispanic (54.8%).  Patients underwent detorsion of adnexal structures and/or resection of adnexal masses or cysts. Nearly one quarter of our study population (26.1%) received a pre-operative bath with CHG.  All patients underwent preparation of skin in the operating room just prior to incision with CHG and isopropyl alcohol skin preparation solution. Overall, the rate of SSIs was 1.7% (n=2) and there were no ER visits or readmissions due to SSIs.  There was no statistically significant difference in outcomes between pediatric patients undergoing pre-operative CHG bath with those not undergoing CHG bath prior to adnexal surgery.

Conclusions:

Our data suggest that pre-operative bathing with CHG does not alter the rates of SSIs, ER visits or readmission rates for pediatric patients undergoing adnexal surgery.  A larger multicenter prospective study would be required to determine a study sufficiently powered to make clinical recommendations.